Free jejunal autograft combined with extensive esophagogastrectomy for unshuntable extrahepatic portal hypertension

摘要: Abstract This is the first report of use a free jejunal autograft vascularized by internal thoracic (internal mammary) artery and vein to restore continuity digestive tract after total gastrectomy distal 65% esophagectomy for recurrent bleeding esophagogastric varices caused unshuntable extrahepatic portal hypertension. The procedure was used in two young adults who, because numerous previous abdominal operations, had severely scarred contracted intestinal mesentery that precluded conventional small or large intestine with an intact blood supply bridge gap between upper esophagus jejunum. Before referral, patients 21 eight bouts variceal hemorrhage, respectively, necessitated cumulative 108 74 units transfusion, 17 12 admissions hospital, failed respond four five operations 14 18 sessions endoscopic sclerotherapy. After extensive esophagogastrectomy combined autograft, both have done well during follow-up 9 3 years, respectively. Both been good excellent health stable weight, freedom from bleeding, normal liver function, no encephalopathy. These results confirm our recently reported conclusions regarding uniform long-term effectiveness treatment hypertension suggest general surgeons familiar microvascular techniques may find be useful various circumstances which it necessary replace all substantial part esophagus. (J THORAC CARDIOVASC SURG 1994;108:346-53)